Abstract: TH-PO857
Effectiveness and Safety of Denosumab on Osteoporosis Treatment in Kidney Transplant Recipients
Session Information
- Transplantation: Clinical - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Park, Woo Yeong, Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)
- Kim, Yaerim, Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)
- Paek, Jin hyuk, Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)
- Jin, Kyubok, Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)
- Han, Seungyeup, Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)
Background
It is known that the use of immunosuppressive agents influences the bone status of kidney transplant recipients (KTRs). In particular, glucocorticoids, the main immunosuppressants, can induce osteoporosis in KTRs. Denosumab, a potent antiresorptive agent, has been reported to increase bone mineral density (BMD), but the clinical impact and safety of denosumab on osteoporosis in KTRs remain controversial.
Methods
We analyzed 98 KTRs who used denosumab from 2018 to 2023. We investigated the change of BMD, chemical parameters, allograft function, tacrolimus trough level (TTL), complications of denosumab, fracture risk assessment tool (FRAX) score, acute rejection within 1 year and graft failure and death.
Results
Mean T-scores at 1-year post-denosumab were significantly increased comparing to mean T-scores pre-denosumab at the femur neck and spine area, respectively (-2.68±0.68 vs. -2.81±0.68, P<0.001; -2.78±0.96 vs. -3.21±1.00, P<0.001). The levels of calcium and phosphorus were significantly decreased and those of vitamin D were significantly increased at 1-year post-denosumab, but there were no significant differences in PTH, allograft function and TTL. There were no recurrent fractures among the 12 KTRs with a history of fracture, but 3 de novo fractures happened. Cardiovascular event occurred in 3 patients. Denosumab-induced hypocalcemia developed in 8 patients, but severe hypocalcemia was observed in only 1 patient. Acute kidney injury did not happen. Urinary tract infection (UTI) was in 17 patients. Arthralgia occurred in 4 patients. Median 10-year probability of a major osteoporotic fracture and hip fracture by FRAX tool was significantly decreased after denosumab. Acute rejection within 1 year after denosumab developed in 3 patients. There was no graft failure and no patient death.
Conclusion
The use of denosumab in KTRs is effective and safe for the treatment of osteoporosis and prevention of fracture, but it should be carefully monitored for complications, especially, UTI.
Figure 1. Mean T score of femur and spine at denosumab and 1 year after denosumab
Funding
- Government Support – Non-U.S.